PREREQUISITES AND PLACEMENT IN THE CURRICULUM: Completion of Surgery Core Clerkship Required.
PURPOSE: The purpose of the rotation is to learn basic treatment strategies in treating critically surgical patients in the intensive care unit and to become familiar with evaluation and management approaches to acute trauma victims. This provides the framework and familiarity for the student to become comfortable in managing acute situations outside of the surgical services. Primarily it will sharpen the use of the basic medical principles learned during the first three years of medical school curriculum.

COMPETENCIES: The expected outcomes for the student is to become comfortable with the management of acutely surgical patients and acute trauma victims. This will include learning ventilator management strategies in treating acute lung injuries, the use of pressors and inotropic drugs in supporting cardiovascular function, the stepwise management of acute intracranial hypertension and the recognition and treatment of various forms of shock. Included in the is the acquisition of technical skills to support the critical patient including, but not limited to central line insertion, arterial line insertion, intracranial pressure monitor insertion and tube thoracostomy.

In addition the student will have the opportunity to participate in the acute assessment and resuscitation of trauma victims and participate in the operative management of these patients. The student will also gain suturing skills if he/she chooses to participate in the trauma side of the service.

The above goals will be accomplished via organized lectures on the topics listed above as well as the day-to-day management of patients with these conditions. The student will also participate in patient case discussions as part of our quality program.

This rotation contributes significantly to the core competencies in the following areas:

- Patient Care: The student will have ample opportunities to assess patients and learn diagnostic skills especially in acute settings.
- Medical Knowledge: The formal didactic program will aid the students in the application of basic principles already learned and increase the depth of knowledge as it relates to the endocrine/metabolic response to surgery and injury
- Practice Based Learning: This rotation will allow the student to identify knowledge gaps in approaching emergency situations and also technical skills that will need to be acquired to be effective in intervening in such circumstances.
- Interpersonal and Communication Skills: The patient population at Mt. Sinai is a diverse population including many cultures that are not commonly familiar to the medical student. In addition to learning how to accommodate cultural differences, learning how to interact in the extremely stressful circumstances of an acutely ill/injured patient will provide invaluable experience for the student as they approach residency training.
- Systems Based Practice: The unique nature of trauma patients that require an organized and integrated approach across many disciplines provides an opportunity for the student learn the role of many practitioners in health care and the collaboration needed to be successful in managing these types of patients.

INSTRUCTIONAL METHOD: The course will be 2-4 weeks in length at the discretion of the student with learning activities to include teaching rounds with the faculty on a daily basis, didactic lectures on Monday, Wednesday and Thursday morning and patient case discussions on Thursday morning as well. Optional activities as participating in operative interventions also represent learning experiences. The student will see and participate in managing a group of acutely ill or injured surgical patients that will include as an emphasis post cardiac patients and trauma patients including a fair number of acute brain injuries.

On-call and outpatient activities are at the discretion of the student and if call is elected it should be no more frequent than 1 in 4 nights. Weekend activities are also at the discretion of the student. Supervision is frequent with twice daily rounds by the faculty and dedicated residents in the ICU who will work closely with the students. Independent reading is always encouraged, but the majority of the education will be from the clinical activities and didactic conferences. Attending/resident instruction will be approximately 25%/75%. Recommended (but not mandated) textbook reading from The ICU Book by Marino and Surgical Critical Care by Civetta, et al. is suggested to augment the educational process

ASSESSMENT: Students will be evaluated by the faculty as to their performance and progress in providing critical care services. This will be performed at the midpoint for those students electing to do a 4 week rotation and will be done by the rotation coordinator in a face-to-face fashion with the core competencies forming the outline of the evaluation.